The field of this invention is medical devices, and more particularly minimally invasive surgical devices.
Minimally invasive medical techniques are aimed at reducing the amount of extraneous tissue which is damaged during diagnostic or surgical procedures, thereby reducing patient recovery time, discomfort, and deleterious side effects. Of the large total number of surgeries performed in the United States each year, it is estimated that significant proportion of these surgeries can potentially be performed in a minimally invasive manner. However, only a fraction of this potential number currently use these techniques due to limitations in minimally invasive surgical instruments and techniques and the additional surgical training required to master them.
Advances in minimally invasive surgical technology could have a dramatic impact. The average length of a hospital stay for a standard surgery is 8 days, while the average length for the equivalent minimally invasive surgery is 4 days. Thus, the complete adoption of minimally invasive techniques could save 28,000,000 hospital days, and billions of dollars annually in hospital residency costs alone. Patient recovery times, patient discomfort, surgical side effects, and time away from work are also reduced with minimally invasive surgery.
The most common form of minimally invasive surgery is endoscopy. Probably the most common form of endoscopy is laparoscopy which is minimally-invasive inspection and surgery inside the abdominal cavity. In standard laparoscopic surgery, a patient""s abdomen is insufflated with gas, and cannula sleeves are passed through small (approximately xc2xd inch) incisions to provide entry ports for laparoscopic surgical instruments.
The laparoscopic surgical instruments generally include a laparoscope for viewing the surgical field, and working tools such as clamps, graspers, scissors, staplers, and needle holders. The working tools are similar to those used in conventional (open) surgery, except that the working end of each tool is separated from its handle by an approximately 12 to 15-inch long extension tube.
To perform surgical procedures, the surgeon passes instruments through the cannula and manipulates them inside the abdomen by sliding them in and out through the cannula, rotating them in the cannula, levering (i.e., pivoting) the instruments in the abdominal wall and actuating end effectors on the distal end of the instruments. The instruments pivot around centers of rotation approximately defined by the incisions in the muscles of the abdominal wall. The surgeon monitors the procedure by means of a television monitor which displays the abdominal worksite image provided by the laparoscopic camera.
Similar endoscopic techniques are employed in arthroscopy, retroperitoneoscopy, pelviscopy, nephroscopy, cystoscopy, cisternoscopy, sinoscopy, hysteroscopy and urethroscopy.
The common feature of all of these minimally invasive surgical techniques is that they visualize a worksite within the human body and pass specially designed surgical instruments through natural orifices or small incisions to the worksite to manipulate human tissues and organs thus avoiding the collateral trauma caused to surrounding tissues which would result from creating open surgical access.
There are many disadvantages to current minimally invasive surgical technology. For example, existing MIS instruments deny the surgeon the flexibility of tool placement found in open surgery. Most laparoscopic tools have rigid shafts and are constrained to approach the worksite from the direction of the small incision. Additionally, the length and construction of many endoscopic instruments reduce the surgeon""s ability to feel forces exerted by tissues and organs on the end effector of the tool. The lack of dexterity and sensitivity provided by endoscopic tools is a major impediment to the expansion of minimally invasive surgery.
As such, there is much interest in the development of new surgical tools for use in minimally invasive procedures that address one or more of the above disadvantages.
U.S. Patents of interest include: U.S. Pat. Nos. 5,997,567; 5,976,122; 5,891,162; 5,820,009; 5,797,959; 5,728,121; 5,713,919; 5,613,973; 5,549,636; 5,417,684; and 5,383,895. See also Doshi et al., J. Rehabil. Res. Dev. (1998) 35:388-395.
Surgical devices and methods for their use in manipulating internal body objects are provided. The subject devices are elongated devices having an elongate member with proximal and distal ends. Located at the distal end is at least one articulated member, and usually two or more articulated members. A manual means for actuating the one or more distal articulated members is located at the proximal end of the device. The elongate members may be flexible or rigid, and both embodiments are encompassed by the subject invention. The subject devices find use in a variety of applications, and are particularly suited for use in applications in which it is desired to manipulate an internal body object from a location external to the body.